HERBAL TRANSITIONS

1 Vol. V, No. 2 HERBAL TRANSITIONS 1 Urinary Tract Infections ..p. 1-5 Interstitial Cystitis ..p. 6 Incontinence ..p. 7-8 Urinary Tract Stones ..p. 9-12 Inside this IssueUrinary TracT HealTHHERBAL TRANSITIONSA botanical newsletter for health care practitionersVolume V Number 2 Winter 2000 Editorial Comment:In an earlier newsletter, we examined kidney health: the etiology, prevention and treatment of acute and chronic kidney failure. After receiving the Kidney Newsletter, many practitioners contacted me to discuss their pa-tients. I am inviting all health care providers to send me the histories of their kidney patients with treatment protocols, and outcomes. This information will be pub-lished in the next newsletter to further our knowledge of kidney disease and its management. Please contact Dr. Tilgner by writing to: PO Box 523, Pleasant Hill, OR 97455, by e-mail: you, Sharol Tilgner Urinary Tract InfectionsA urinary tract infection (UTI) occurs when predisposing factors create an environment for an infecting organism to set up house in the urinary tract.

2 This elicits an inflammatory response from the of UTIs:1. Cystitis: bladder infection (most common infection)2. Urethritis: urethra infection3. Pyelonephritis (PN): kidney infection4. Prostatitis: prostate infection - discussed in our newsletter called Prostate HealthPredisposing Factors to UTIs: Obstructions - stones, tumors, strictures New or multiple sexual partners Stress Diabetes mellitus Food allergies Chemical sensitivities Candida overgrowth Bowel toxemia High sugar intake Vigorous sexual intercourse Decreased immunity Diaphragm use or misuse Vesicovaginal fistula Lack of local defense system - this is considered the cause of recurrent UTIs in many women. A lack of local defense may allow colonization of bacteria on the vaginal vestibule. These women usually have decreased cervicovaginal antibodies to enterobacteria. These factors lead to an increased number of abnormal organisms in the vagina that are capable of ascend-ing the urinary tract through the of Patient:As natural health care practitioners, there are numerous questions we must ask ourselves about our individual patients with a UTI.

3 2 HERBAL TRANSITIONS Vol. V, No. 2 HERBAL TransitionsPublished by Wise AcresPrinted on recycled paperFor example:1. Is this health condition due to excess (such as a raging hot infection) or deficiency (such as a chronic immune deficient situation with flaccid, unresponsive tissues)? 2. Is the UTI due to an external pathogenic factor or to internal disharmony? 3. A thorough case history is important. Get specifics about the situation and the patient. Bladder Infections (Cystitis) Prevalence:Bacterial bladder infections are 10 times more frequent in females that in males, except in neonates where it is almost equal in males and females. 6% of women have annual UTIs. 80% of bladder infections are associated with , a common gastrointestinal tract bacteria which responds well to arbutin, a constituent in Arctostaphylos uva-ursi and Chimaphila umbellata.

4 Categories of Bladder Infections: 1. Acute cystitis (also known as first infection) is a solitary event. It has no relation to any other infection or infecting organisms. Usually it is caused by autoinfection from the patient s fecal stream by an E. coli organism. The organism is usually sensitive to almost any antimicrobial used for UTI. 2. Recurrent infection (also known as reinfection) is a series of infections that are separated by at least 3 or 4 weeks. The infectious episodes are generally associated with a dif-ferent organism or different serotype each time. It is the most common type of repeat infection, especially in women. 3. Relapsing infection (also known as bacterial persistence) results when the infecting organism persists after treat-ment with an effective antimicrobial. Most common causes of these: Infected calculi/stones (usually in upper tract) Foreign body Chronic bacterial prostatitis Chronic pyelonephritis (usually unilateral and atrophic) Pericalyceal cysts or old communicating abscess cavities Congenital anomalies Urethral diverticula Vesicoenteric fistulaeIt is futile to treat these infections unless the underlying cause is Unresolved bacteriuria results when the antimicrobial used was inadequate or never sterilized the urine.

5 Oc-casionally more than one affecting organism is involved. The sensitive organism is eradicated by the antimicrobial and the nonsensitive species comes forth. Etiology and Pathogenesis (Cause): Mainly coliform bacteria, usually E coli strainsGram-positive aerobic bacteria, usually Staphylococcus saprophyticus and ascends from greater in girls and women - consider reflux, constipa-tion, sexual activity, diaphragm use, after age 50 - consider obstruction of the cystitis is rarely found in infection may lead to hemorrhagic cystitis in children. Symptoms:Irritative voiding (a keynote of cystitis) Frequency Urgency Burning on urination Low back and suprapubic pain. Urge incontinence Hematuria (in 30% of patients) Fever uncommon Urinates in small amounts Nocturia Complains of foul-smelling urine Dysuria May be asymptomatic in elders Signs: No specific physical signs are characteristic.

6 Possible associated contributing factors: Vaginal, introital or urethral abnormalities Vaginal discharge Urethral discharge in males Swollen, tender prostate or epididymis in males Abnormal Laboratory Findings:UA: Pyuria Bacteriuria Gross or microscopic hematuria may be seen Instrumental Examination:Cystoscopy when hematuria is prominent, but delay procedure until acute phase is over and infection has been adequately treated . Differential Diagnosis (DDX):1. Females: Vulvovaginitis - rule out with pelvic examination and examination of vaginal discharge for Children: Vulval and urethral irritation - caused by bubble bath or Males: Infections of urethra, prostate and kidney-appropriate PE and lab Noninfectious types of cystitis: Resulting from anticancer therapy ( irradiation, cyclophosphamide), interstitial cystitis, eosinophilic cystitis, bladder carcinoma Sharol Tilgner , Managing EditorVicky Crouse , Associate EditorJames Reiley , Associate EditorLynn Buckman.

7 , Associate EditorBeth Scandalios, Edit & DesignDeborah Fratz, IllustratorVol. V, No. 2 HERBAL TRANSITIONS 3(especially carcinoma in situ), and psychosomatic Acute urethral syndrome - urine cultures show low counts or no growth of Acute pyelonephritis - loin pain and significant fever. Complications:Ascends to Kidney (KI): Children with vesicoureteral reflux and pregnant women are especially persistent cystitis - development of infected calculi in upper urinary tract and bladder or secondary infection of prostate or epididymis. Kidney Infection (Pyelonephritis PN) Etiology:Involves both parenchyma and pelvis of the kidney. It may affect one or both kidneys. E. coli is the predominant patho-gen, but also consider Proteus species, Klebsiella species and occasionally S. epidermidis, S. saprophyticus, S. aureus and streptococci group D. Pathogenesis:Usually ascends from the urethra and lower genitourinary are less susceptible due to the longer urethra and antibacterial factors secreted by prostate.

8 Symptoms of PN: Abrupt onset of shaking chills Moderate to high fever Flank pain Nausea Vomiting Significant malaise and prostration 1/3 of patients have a concomitant lower UTI Signs: Quite ill Tachycardia Abdominal distention 101-104 F temperature Rebound tenderness Auscultation usually reveals a quiet intestine Percussion of CVA (costovertebral angle) causes pain Lab Findings: Significant leukocytosis Increased SED rateUA: Cloudy urine Heavy pyuria Bacteriuria Mild proteinuria Microscopic or gross hematuria Leukocyte casts and glitter cells >100,000 colonies/mL Perform serial blood cultures Differential Diagnosis (DDX): Pancreatitis Basal pneumonia Acute appendicitis Cholecystitis Diverticulitis PID in women Acute prostatitis Acute epididymoorchitis Renal abscess Perinephric abscess Complications:Complications are uncommon in adults, treated appropriately and without renal disease or urologic abnormalities.

9 In chil-dren or infants whose renal development is not complete, PN often produces permanent renal damage and scarring. They must be thoroughly evaluated and vigorously most serious complication is septicemia complicated by shock. It is unusual, but often HERBAL TRANSITIONS Vol. V, No. 2 Conventional Treatment:In severe or complicating factors hospitalization is and blood cultures will identify the (amikacin, gentamicin or tobramycin) plus ampicillin-IV x 1 week then replace with appropriate oral drug x 2 bed rest with fluids - IV and response after 48-72 hrs of therapy, reevaluation for possible complicating factors ( , obstructive uropathy) or inappropriate drugs. Repeat cultures up to 6 of Urinary Tract Infections Avoid: Nylon underwear Sitting on cold floors & hot radiators Baths, use showers Pantyhose Tight pants Swimming in chlorinated pools Fried Foods Sexual partner with dirty fingers Sugar Sitting around in wet bathing suits Caffeine Soaps that contain perfumes, colorations Dairy Vaginal intercourse after anal intercourse Refined Foods Vaginal douches and sprays with Alcohol Perfumes, colorations or other chemicals Clothing that increases heat and perspiration in the perineal area Reduce Risk Factors: Wipe from front to back when voiding.

10 Drink plenty of water. Drink nettle tea. Urinate after sexual intercourse. Keep the genital area clean. Urinate whenever you feel the urge. Wash clothing with non-scented detergents. Drink unsweetened cranberry juice. Combine a cup of water and a handful of berries in the blender. If UTI is Suspected: Drink plenty of water to flush out the bacteria and prevent spread of the infection to the kidneys. Drink unsweetened cranberry have shown that it's the mannose in cranberry juice that does the job. If the UTI is caused by E. coli then the germs take in the mannose and discover that they can no longer adhere to the walls of the urinary tract. If your UTI is caused by another organism then cran-b e r r y j u i c e , m a n n o s e c a n n o t help." Avoid caffeine, nicotine, sugar and alcohol. Use hot and cold alternating sitz baths: 3 minutes warm and 1 minute cold to improve pelvic circulation.